Comparative effectiveness of fingolimod versus interferons or glatiramer acetate for relapse rates in multiple sclerosis: a retrospective US claims database analysis. (December 2013)

• Record Type: Journal Article
• Authors: Bergvall, Niklas; Makin, Charles; Lahoz, Raquel; Agashivala, Neetu; Pradhan, Ashish; Capkun, Gorana; Petrilla, Allison; Karkare, Swapna U.; Balderston McGuiness, Catherine; Korn, Jonathan R.
• Is Part Of: Current medical research and opinion. Volume 29:Number 12(2013:Dec.)
• Page Start: 1647
• Page End: 1656
• Publication Date: 2013-12
• Subjects: Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1185/03007995.2013.847411
• Languages: English
• ISSNs: 0300-7995

Abstract

<abstract> <title>Abstract</title> <sec id="ss1"> <title>Objective:</title> <p>Disease-modifying therapies, such as fingolimod, interferon (IFN) and glatiramer acetate (GA), have differing effects on relapse rates in patients with multiple sclerosis (MS), but little is known about the real-world differences in relapse rates with these treatments. This retrospective study assessed relapse rates in patients with active MS initiating fingolimod, IFN or GA therapy in a real-world setting.</p> </sec> <sec id="ss2"> <title>Methods:</title> <p>Using administrative claims data from the US PharMetrics Plus database, we identified previously treated and untreated patients with MS who initiated fingolimod, IFN or GA treatment between 1 October 2010 and 31 March 2011 and had experienced a relapse in the previous year. A claims-based algorithm was used to identify relapses over the persistence period in patients with 540 days of post-index continuous enrolment. A logistic regression model assessed the probability of having at least one relapse and a generalized linear model estimated differences in annualized relapse rates (ARRs).</p> </sec> <sec id="ss3"> <title>Results:</title> <p>The study enrolled 525 patients (fingolimod, <italic>n</italic> = 128; combined IFN/GA cohort, <italic>n</italic> = 397) of the 31, 041 initially identified. Similar findings for fingolimod and IFN/GA were observed for the unadjusted proportion of patients experiencing relapses (31.3% vs. 34.0%, respectively; <italic>p</italic> = 0.5653) and ARRs (0.50 vs. 0.55, respectively) while persistent to treatment. After adjusting for baseline differences, fingolimod was associated with a 52% reduction in the probability of having a relapse (odds ratio, 0.48; 95% confidence interval [CI], 0.28–0.84; <italic>p</italic> = 0.0097) and a 50% reduction in ARR (rate ratio, 0.50; 95% CI, 0.34–0.75; <italic>p</italic> = 0.0006) compared with IFN/GA.</p> </sec> <sec id="ss4"> <title>Limitations:</title> <p>Identification of relapses is based on the claims in the database rather than on a clinical assessment.</p> </sec> <sec id="ss5"> <title>Conclusions:</title> <p>In a real-world setting, fingolimod was shown to be associated with significantly lower relapse rates than IFN/GA in patients with MS who had a history of relapses.</p> </sec> </abstract>